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News, commentary and analysis for reproductive and sexual health and justice.Tue, 03 Mar 2015 18:01:49 +0000en-UShourly1http://wordpress.org/?v=4.1.1Catholic Hospitals’ Practices Fall ‘Below the Radar’http://rhrealitycheck.org/article/2011/01/27/catholic-hospitals-practices-fall-below-radar/?utm_source=rss&utm_medium=rss&utm_campaign=catholic-hospitals-practices-fall-below-radar
http://rhrealitycheck.org/article/2011/01/27/catholic-hospitals-practices-fall-below-radar/#commentsThu, 27 Jan 2011 14:54:07 +0000Just weeks ago, St. Joseph's Hospital in Arizona saved the life of a young mother of four with an emergency abortion. Join us to ensure that all U.S. Catholic hospitals protect patients' rights and are held to the highest standard of care.

This is cross-posted from the National Women’s Law Center’s blog Womenstake

If you have any social life whatsoever, eventually you will find yourself talking about what you do for a living. My day job is making sure that women’s access to reproductive health care isn’t compromised by the religious beliefs of their hospitals and health care providers. If you don’t think this is great cocktail party fodder, you have different friends than I do.

There is compelling evidence that Catholic hospitals sometimes delay or deny treatment to women with certain pregnancy complications. Why? Because doctors can still detect a heartbeat, but we are talking about cases where there is no medical treatment that would allow these pregnancies to continue. These women are experiencing what is called in the medical literature an “inevitable abortion.” Ectopic pregnancies (those that grow in a fallopian tube) are also never viable. The standard of care requires medical intervention to end these pregnancies because the patients are at risk for hemorrhaging, infection, or in the case of ectopic pregnancies, a tubal rupture that could be fatal. Regardless of where someone stands on the abortion issue, every person I’ve ever discussed this with has been absolutely appalled that this happens.

We are greatly encouraged that this issue has caught the attention of the Washington Post and the New York Times’ Nicholas Kristof. To put an end to these practices, NWLC is asking the Department of Health and Human Services to find that these practices violate federal laws that protect patients’ right to receive the standard of care, emergency care, and adequate information on their treatment options.

We urge you to share your story if you’ve been denied appropriate treatment of your pregnancy complications, to take the pledge to get informed, and to let others know about this issue. We hope that these dangerous practices won’t be Below the Radar for much longer.

]]>http://rhrealitycheck.org/article/2011/01/27/catholic-hospitals-practices-fall-below-radar/feed/82Idaho Pharmacy Board Gives a Pass to Pharmacist Who Refused to Fill Prescriptionhttp://rhrealitycheck.org/article/2011/01/26/idaho-pharmacist-refused-fill-prescription-getspass/?utm_source=rss&utm_medium=rss&utm_campaign=idaho-pharmacist-refused-fill-prescription-getspass
http://rhrealitycheck.org/article/2011/01/26/idaho-pharmacist-refused-fill-prescription-getspass/#commentsWed, 26 Jan 2011 16:09:34 +0000The Walgreens pharmacists who placed a woman's life in potential danger by refusing to fill a prescription for methergin - a medication which stops uterine bleeding - and who also refused to refer a nurse practitioner to another pharmacy will walk away without discipine from the Idaho Board of Pharmacy.

]]>The Idaho Board of Pharmacy has ruled that the Walgreens pharmacist who refused to fill a prescription for Methergine – a medication that halts uterine bleeding – will not be disciplined for her actions. The prescription was called in by a nurse practitioner with a local Planned Parenthood. The Idaho Press-Tribune reports that “the board had concluded its investigation into the incident and found no violations of state laws the board is tasked with enforcing.”

According to initial reporting about the story, the pharmacist “suspected” the Methergine prescription may have been called in on behalf of a woman who had undergone an abortion. She asked the nurse practitioner for what reason she was prescribing the medication, and when the nurse practitioner told the pharmacist providing that information would violate patient confidentiality, the pharmacist not only refused to fill the prescription – but refused to refer the nurse practioner to another pharmacy.

“The board basically told us that according to Idaho law, there is no duty to dispense any drug,” Kristen Glundberg-Prossor, director of public affairs for Planned Parenthood, told Boise Weekly’sCitydesk. “In essence, they told us no harm, no foul…What that means is that any pharmacist can refuse to fill any prescription at any time for any reason.”

“The pharmacist invoked the state’s new so-called conscience clause that allows pharmacists to refuse to fill prescriptions for emergency contraceptives and abortifacient drugs, among other things, if they have a personal problem with it.”

The disconnect, in this case, comes from the fact that two separate policies are being invoked. The Idaho Pharmacy Act allows for a pharmacist to refuse to fill a prescription – for any reason essentially. The State Board is tasked with overseeing enforcement of this law. However, according to the American Pharmacists Association’s code of ethics, while pharmacists have the right to “exercise conscientious refusal,” patients also have the right to access legally-prescribed medication. The organization notes that:

“When this policy is implemented correctly, and proactively, it is seamless to the patient, and the patient is not aware that the pharmacist is stepping away from the situation. In sum, the APhA supports the ability of the pharmacist to step away, not in the way, and supports the establishment of an alternative system for delivery of patient care.”

The Conscience Clause, put into law last year in Idaho, specifically allows for pharmacists to refuse to fill prescriptions for abortifacient medication or emergency contraception, among other medications. However, Methergin does not fall into either of these categories. It does not cause an abortion, nor is it contraceptive. The law also clearly states that in life-threatening situations a healthcare professional must provide care until an alternative is found.

If a health care professional invokes a conscience right in a lifethreatening situation where no other health care professional capable of treating the emergency is available, such health care professional shall provide treatment and care until an alternate health care professional capable of treating the emergency is found.

Still, as Idaho’s State Board of Pharmacy Executive Director, Mark Johnston notes, the conscience clause is not under the Board’s domain. This won’t stop Planned Parenthood of the Greater Northwest, however, from taking action.

Glundberg-Prosser told the Idaho Press-Tribune that they’d press for changes to or a repeal of the state’s conscience law.

]]>Even as state legislators were largely preoccupied by ongoing budget crises in 2010, issues related to reproductive health and rights nonetheless garnered significant legislative attention. More than 950 such measures were introduced in the District of Columbia and the 44 states in which the legislatures convened.

By year’s end, 89 new laws had been enacted in 32 states and DC. (This is an increase from the 77 laws enacted in 2009 and the 33 statutes enacted in 2008.) As always, abortion received the lion’s share of the legislative attention, accounting for 39 of the 89 new laws. While the new abortion laws are overwhelmingly restrictive, the reinstatement of public funding for abortion in DC (permitted by federal law for the first time in almost three decades) is a notable exception.

States were also able to take some significant steps to promote reproductive health in other areas, however, by mandating that sex education be comprehensive and medically accurate; requiring coverage of contraception in health insurance plans; and allowing a health care provider to prescribe treatment for a patient’s partner for STIs.

Abortion

Over the course of the year, 15 states enacted 39 laws related to abortion. The most high-profile abortion-related debate in 2010 came as the result of the passage of the federal health care reform legislation in March, the peak of the state legislative year. By year’s end, legislators in 14 states had introduced measures relating to insurance coverage of abortion in the exchanges that will be established as a result of health care reform; new laws were enacted in five states and vetoed in Florida and Oklahoma.

Laws enacted in Arizona, Mississippi and Missouri limit abortion coverage to extremely rare cases, such as life endangerment, severe health impairment, rape or incest; the laws enacted in Louisiana and Tennessee prohibit coverage of abortion altogether (see Restricting Insurance Coverage of Abortion). The Missouri law, which prohibits abortion coverage except in cases of life endangerment, applies to all insurance policies written in the state, whether or not they are offered through an exchange; four other states have similar blanket restrictions. Arizona, meanwhile, moved to restrict the insurance coverage for abortion offered to state employees to cases where the woman’s life is endangered or her health threatened, bringing to 12 the number of states limiting coverage for public employees.

In a groundbreaking move, Nebraska used largely scientifically suspect claims about the ability of a fetus to feel pain to justify legislation banning abortion after 20 weeks’ gestation, except in cases of life endangerment or when necessary to “avert substantial and irreversible impairment of a major bodily function.” Although the law conflicts with several Supreme Court rulings that abortion must be permitted until viability (which generally occurs between 24 and 26 weeks’ gestation), the measure has not been challenged and is in effect. Moreover, the law is serving as a model for legislative action in other states. Including Nebraska, 38 states restrict later-term abortions (see Policies on Later-Term Abortion).

In another attempt to ban abortion, antichoice activists in Colorado put an initiative on the ballot that would have defined a fetus, for purposes of Colorado law, as a “human being from the moment of conception.” The measure was soundly rejected by voters in November; it had met the same fate in 2008. Taking different approaches to the same goal of banning at least some abortions, Oklahoma moved to ban abortions for purposes of sex selection and Utah enacted a measure that makes self-inducing an abortion illegal.

In August, the District of Columbia resumed funding abortion services for low-income women. The ability of the District to use its own locally raised revenues had been restricted by Congress since the early 1980s; this prohibition was lifted beginning with fiscal year 2010. The DC policy change brings to 18 the number of jurisdictions that fund abortion services (see State Funding of Abortion Under Medicaid). A measure enacted by Arizona limits funding to cases of life endangerment, rape or incest; the state, however, remains under a court order to fund all or most medically necessary abortions, although it does not appear that eligible procedures are actually being funded.

Three of the 24 states that require a woman seeking an abortion to receive counseling designed to deter her from having the procedure moved to tighten their existing mandates (see Counseling and Waiting Periods for Abortion). A law adopted in Nebraska would have required abortion counselors to inform women that they are at high risk of adverse consequences resulting from an abortion because of their physical, psychological, demographic or situational circumstances; the measure was immediately challenged and never went into effect. Missouri expanded its counseling law to require abortion counseling materials to state that abortion terminates the “life of a separate, unique, living human being;” it also requires that a woman seeking an abortion after 21 weeks’ gestation be told that a fetus can feel pain beginning at 22 weeks’ gestation. Finally, South Carolina expanded the required waiting period between the counseling session and the abortion procedure from one hour to 24 hours.

Six states with existing abortion counseling requirements either instituted or expanded provisions related to ultrasound. Oklahoma brought back a provision that was enacted in 2008, but voided by state court on purely procedural grounds. The law requires that a woman seeking an abortion undergo an ultrasound, receive a verbal description of the image and be shown the monitor; the law does, however, permit her to “avert her eyes” while the image is displayed. The measure, which is stricter than that in effect in any other state, was immediately challenged and enforcement is enjoined. Louisiana, which already required that a woman seeking an abortion undergo an ultrasound, expanded its mandate to require that the woman be given the option to view the image and hear a verbal description. (A separate provision of the Louisiana law that would have required that the woman be given a hard copy of the ultrasound image was struck down in court.) Including the new Louisiana law, five states have ultrasound mandates in effect (see Requirements for Ultrasound). Stopping short of actual mandates, Utah and West Virginia adopted measures requiring women to be given the option to view an ultrasound image if the procedure is performed; Missouri and South Carolina require that women be offered the option to have an ultrasound performed prior to an abortion.

A handful of states took actions related to minors seeking an abortion. In the most high-profile move, voters in Alaska approved a ballot initiative requiring parental notification for a minor seeking an abortion; this brings to 36 the number of states requiring parental involvement (see Parental Involvement in Minors’ Abortions). Two states enacted measures requiring detailed reporting related to a minor’s abortion. New laws in Arizona and Oklahoma require abortion providers to give the state information on the number of minors requesting a judicial bypass and the number of petitions approved by the courts; this brings to 11 the number of states with reporting requirements specific to minors. Both of these states also expanded their overall abortion reporting requirements to include, among other topics, the woman’s reason for obtaining an abortion. Gov. Mark Parkinson (D) vetoed a similar measure in Kansas (see Abortion Reporting Requirements).

Virginia joined Montana and Pennsylvania in authorizing the sale of prochoice license plates; funding generated by the sale of the “Trust Women/Respect Choice” plates will be used to support family planning services in the state. At the other end of the spectrum, Delaware became the 23rd state to authorize the sale of “Choose Life” license plates (see ‘Choose Life’ License Plates). Louisiana, which has offered the license plates for many years, increased the purchase price; the proceeds are earmarked for support of alternatives-to-abortion services. Kansas, Missouri and Pennsylvania also continued state funding for these alternative services.

Three states enacted laws related to abortion facilities. Tennessee and Oklahoma approved measures that require facilities where abortions are performed to post a notice stating that women cannot be coerced into having an abortion and informing them that they can contact a law enforcement agency if they feel that they have been the victim of coercion. Louisiana, meanwhile, authorized the closure of any abortion provider found to be in violation of federal or state law, a stricter standard than under previous law, which had permitted closure only for a “substantial” failure to comply with legal mandates.

Two states adopted other measures related to abortion providers. Louisiana enacted a measure that denies abortion providers who perform “elective” abortions after viability the protections of medical malpractice law, even though state law permits abortions after viability when the woman’s life or health is endangered (see Policies on Later-Term Abortions). The Oklahoma legislature, meanwhile, overrode the governor’s veto to enact a measure that protects health care providers who withhold information from women who might otherwise choose abortion. In a separate measure, Oklahoma also moved to limit the provision of medication abortion only to physicians.

Sex Education

Measures relating to sex education were introduced in 27 state legislatures in 2010, but only one was enacted. The new law in Wisconsin mandates that sex education be taught in schools throughout the state. The law also requires that the education provided be medically accurate and include discussion of both abstinence and contraception. The law makes Wisconsin one of 20 states (plus DC) to mandate sex education; 13 states require that the materials be medically accurate, while 18 states and DC require discussion of contraception (see Sex and HIV Education).

Refusal to Provide Health Services

Over the course of 2010, measures allowing health care providers to refuse to provide reproductive health care were introduced in 14 states and enacted in Idaho and Oklahoma. A new law in Idaho permits health care providers, including pharmacists, to refuse to provide services related to either abortion or contraception, based on a moral, religious or ethical objection. Under the law, an employer, such as a pharmacy, must accommodate an employee’s refusal as long as it does not cause an “undue hardship” for the business.

Including Idaho, 14 states permit providers to refuse to provide contraceptive services (see Refusing to Provide Health Services) A law enacted in Oklahoma expands the group of providers permitted to refuse to participate in services related to abortion to include any health care provider in the state, except in cases of life endangerment.

Pregnancy and Birth

Five states enacted legislation related to pregnancy and birth in 2010. Kansas adopted a measure that requires HIV testing for pregnant women and newborns, unless the mother refuses. Kentucky and Minnesota adopted measures aimed at promoting substance abuse treatment for pregnant women. The Kentucky statute allocates funding for substance abuse prevention and treatment for pregnant women. The measure adopted in Minnesota allows a medical provider to treat a pregnant woman who is using either alcohol or marijuana without having to report her substance use to law enforcement agencies. A new Tennessee statute allows a woman who had a miscarriage to obtain a “certificate of stillbirth” from the state. Tennessee also adopted a law that establishes additional penalties for the murder of a pregnant woman, and Utah adopted a new law that criminalizes a woman’s “intentional or knowing” act that results in a miscarriage.

Contraception and Prevention

Colorado enacted a measure that requires health insurance plans in the state to include coverage of all FDA-approved contraceptive methods. The measure applies to both group and individual plans. Including Colorado, 28 states mandate contraceptive coverage (see Insurance Coverage of Contraceptives).

Four states enacted legislation expanding access to treatment for STIs by permitting health care providers to prescribe medication for a patient’s partner without having to examine the partner. The new law in Maine applies to all STIs. The law in Wisconsin applies to chlamydia, gonorrhea and trichomoniasis, while the laws in Missouri and Rhode Island apply only to chlamydia and gonorrhea treatment. Enactment of these measures brings to 21 the number of states that permit expedited partner treatment (see Expedited Partner Therapy).

Two states reenacted long-standing abortion-related restrictions on state family planning funds (see State Family Planning Funding Restrictions). As a result, Colorado will continue to refuse to allocate state family planning funds to agencies that use their own revenue to provide abortion services, and Michigan will continue to prohibit the use of state funds to provide counseling or referral for abortion. Three other states have some sort of similar funding restriction. In Kansas, meanwhile, the governor vetoed a provision that would have given priority in the competition for state family planning funds to health departments, hospitals and federally qualified health centers, effectively limiting access to Planned Parenthood clinics that provide abortion services.

Environmental Hazards to Reproductive Health

Beginning in 2011, the Guttmacher Institute will be expanding its monitoring of state policy development to include environmental hazards to reproductive health. This expansion of our state effort reflects growing interest in these issues at the state level. Information on state policymaking on these issues will be included in the monthly state update and chart of enacted legislation posted on the State Center on the Guttmacher Web site.

In some cases, state action on these issues is the direct result of adverse reproductive health consequences. For example, several states have moved to ban parabens in cosmetics specifically because of the damage caused by these substances to women who work in nail and hair salons. However, the bulk of state policymaking seeks to limit exposure to substances that can have a wide range of adverse health consequences, including for reproductive health. For that reason, we will monitor policymaking related to eight substances that not only have known adverse reproductive health consequences, but also are likely to have a disproportionate impact on disadvantaged communities: Bisphenol-A (BPA), dioxin, flame retardants, lead, mercury, parabens, pesticides and phthalates. Two of these substances, BPA and mercury, received significant attention in state legislatures in 2010.

BPA, a key component of many low-cost plastics, such as reusable food containers, plastic bottles (including baby bottles) and the lining of aluminum cans, has been associated with serious reproductive health impacts, including an increased risk of miscarriage, decreased sperm quality, abnormal egg and uterus development, and early onset of menarche (see BPA-Free and Beyond: Protecting Reproductive Health from Environmental Toxins). Partly because of these adverse reproductive health impacts, five states (Maryland, New York, Vermont, Washington and Wisconsin) enacted legislation to restrict BPA in 2010.

Mercury, a heavy metal, has been associated with decreased fertility in both men and women, changes in the length of a woman’s menstrual cycle, painful periods and an increased risk of poor birth outcomes, including miscarriage and low birth weight. Mercury exposure can occur during a product’s manufacture or use; it can also result from improper disposal, leading to an excessive risk to individuals in some occupations and to communities located near landfills. During the 2010 legislative sessions, nine states (Illinois, Maine, Maryland, North Carolina, Rhode Island, Tennessee, Vermont, Virginia and Washington) enacted legislation to regulate mercury disposal or require recycling of products containing mercury, in part because of their consequences for reproductive health.

]]>http://rhrealitycheck.org/article/2011/01/07/state-legislative-trends-2010-abortion-restrictions-once-again-dominate/feed/1Always Let Your Conscience Be Your Guide?http://rhrealitycheck.org/article/2009/07/29/always-let-your-conscience-be-your-guide/?utm_source=rss&utm_medium=rss&utm_campaign=always-let-your-conscience-be-your-guide
http://rhrealitycheck.org/article/2009/07/29/always-let-your-conscience-be-your-guide/#commentsWed, 29 Jul 2009 14:20:28 +0000Can I both support a pastor’s right
to refuse to marry people and oppose a pharmacist’s right to refuse to
dispense prescriptions? Or does support of one logically require
support of the other?

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Ever since I first learned about “conscience clauses,” which allow
medical providers to refuse to provide medical treatment or referrals
based on their own personal beliefs, they have fascinated me. I find
pharmacist refusal clauses to be particularly interesting. While I
whole-heartedly support each and every person’s right follow his or her
conscience, I, as an RJ advocate, can’t help but notice that one
person’s conscientious refusal is another person’s barrier to obtaining
a necessary reproductive health service (for example, emergency
contraception). In rural communities, which may only have one pharmacy
or pharmacist, a conscientious refusal can altogether prevent
women from obtaining the health care services they need. I find myself
thinking, “you are a pharmacist, dispensing prescriptions and
behind-the-counter medication is your job – so do your job.”
Nonetheless, I am uncomfortable compelling individuals to perform an
action merely because that action is a commonly accepted practice in
the profession.

A perfect case-in-point is the emerging “Refuse to Sign”
campaign. Begun by clergy in Ohio, the Refuse to Sign Campaign seeks
“the separation of church and state by advocating equal marriage rights
for all people, regardless of sexual orientation, by encouraging faith
communities, and their leaders, not to sign state-issued marriage
licenses.” Some religious leaders are merely refusing to sign the
licenses; some are refusing to perform marriage ceremonies at all.
Following my pharmacist refusal logic, I should think that performing
marriage ceremonies is the clergy’s job, and they should do it. But I
don’t. I realize that the analogy isn’t a perfect fit, but it raises
some interesting questions for me. Can I both support a pastor’s right
to refuse to marry people and oppose a pharmacist’s right to refuse to
dispense prescriptions? Or does support of one logically require
support of the other?

Supporting the clergy’s refusal and opposing pharmacists’ refusal is
logically consistent from an RJ perspective – we support both the right
of all to enjoy equal protection of the law and we support equal access
to contraception. But is it logically inconsistent from a moral
perspective? If I believe, as I do, that everyone should follow his or her conscience, do I have to support the effects of doing so?

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Sens. Hillary Clinton and Patty Murray have introduced legislation that would block new Department of Health and Human Services provider conscience regulations from going into effect, Planned Parenthood Federation of America announced today. The
proposed HHS rule would require any health care entity that receives
federal funds certify that none of its employees are
required to assist with medical services they find
objectionable.

The Protecting Patients and Health Care Act block HHS from finalizing or implementing the regulations, so the legislation will have an impact even if it passes after the regulations have been promulgated. "This legislation sends a strong message to administrative
agencies that Congress is willing to act when agencies exceed their authority by
going beyond the scope of existing laws and congressional intent," says Planned Parenthood spokesperson Diane Quest.

"In
the final days of his administration, the President is again putting
ideology first and attempting to roll back health care protections for
women and families," said Sen. Clinton in a statement. "The fact that the [Equal Employment Opportunity Commission] was never
consulted in the drafting of this rule further illustrates that this is
purely a political ploy." In fact, EEOC officials have publicly opposed the rule, saying that the regulations upset the balance between respect accorded to provider and patient conscience.

Clinton and Murray met with HHS Secretary Michael Leavitt in September to express their concern over the new regulation, but received no assurances that the regulation wouldn’t impede women’s access to basic health care services like contraception. "While I appreciate the Secretary sitting down with us today, we
received no guarantee that women’s access to contraceptives will be protected
if these rules move forward," Sen. Murray said at the time. And in July, twenty-eight senators joined Clinton and Murray in signing a letter in opposition to the new regulations (President-Elect Obama was one of the signatories). Clinton and Murray are long-time champions of women’s health; by holding up Andrew von Eschenbach’s confirmation as permanent FDA commissioner, the pair forced the FDA to approve emergency contraception for over-the-counter access.